الفهرس 
Chapter 1: Auditing in HD unitsOnly 14 pages are availabe for public view
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Abstract
Dialysis is defined as the diffusion of molecules in solution across a
semipermeable membrane along an electrochemical
concentrationgradient.Theprimarygoalofhemodialysisisto restore the
intracellular and extracellular fluid environment that is characteristic of normal
kidney function.
End-stage renal disease (ESRD) is defined as irreversible decline in a
person’s own kidney function, which is severe enough to be fatal in the absence
of dialysis or transplantation. ESRD is included under stage 5 of the National
Kidney Foundation Kidney Disease Outcomes Quality Initiative classification
of chronic kidney disease (CKD), where it refers to individuals with an
estimated glomerular filtration rate less than 15 mL per minute per m2 body
surface area, or those requiring dialysis irrespective of glomerular filtration
rate.
Infection is the most common cause of hospitalization and the second
most common cause of mortality among hemodialysis (HD) patients, after
cardiovascular disease. HD patients are exposed to different types of infection,
which include bloodstream infections and localized infections of the vascular
access, blood-borne infections with hepatitis B virus (HBV), hepatitis C virus
(HCV) and/or human immunodeficiency virus (HIV) and airborne infections
like tuberculosis.
Studies showed that the main route of transmission of HAIs is via the
transiently contaminated hands of the HCW. Therefore, hand hygiene is singled
out as the most important infection prevention intervention. However, the
compliance rates of HCWs in hand hygiene is very poor, with an overall
average of only 40%. Based on hand hygiene indications as per
recommendations from the APIC, CDC and World Health Organization
Summary and Conclusion
76
(WHO) we estimated the number of times a single dialysis staff is required to
perform hand hygiene per HD session per patient .
The large number of times an HD staff is required to perform hand
hygiene could be a reason for lack of compliance. However, compliance can be
improved by continuous education and supervision, and by providing, in
convenient locations, a sufficient number of sinks with soap dispensers, paper
towels, hand lotions (e.g., one for every two to four dialysis stations) and
alcohol-based hand rubs (ABHRs) placed at each patient station.
Personal protective equipment (PPE) refers to a variety of barriers and
respirators used alone or in combination to protect mucous membranes,
airways, skin and clothing from contact with infectious agents. Sterile gloves
must be used during procedures requiring a sterile aseptic technique, such as
during catheter insertion or at any time a dialysis catheter is
handled/manipulated.
Audit originates from the Latin term “Audire” which means “to hear”
just as in ancient times auditors used to listen to officers and people of authority
to confirm the validity of their words.
Audit is a systematic, independent and documented process for obtaining
objective evidence and evaluating it objectively to determine the extent to
which the audit criteria are fulfilled or put simply; an audit is a means to
establish the extent to which performance meets the objectives for that
performance.
The aim of the work is to assess the implementation of CDCrecommended practices for infection prevention in hemodialysis facilities. This
will be achieved by performing auditing to health care providers’ infection
control related practices in HD units in the South Sinai Governorate, Egypt.
Summary and Conclusion
77
All hemodialysis units (HDU) of South Sinai were included in the study
and all nurses were invited to participate in the study and to fill in a selfadministered questionnaire.
Patients and worker staff in hemodialysis units in south Sinai Hospital’s
according to inclusion criteria
We summarized our results as the following:
Regarding age group, 0 were age <20, 22(46.8) were 20 years old,
21(44.6) were 30 years old, 9(19.1) were above 40 years. Regarding
Level of education,19(40.4) graduated from School of nursing,
23(48.9) graduated from Nursing institutes, 5(10.6) graduated from
Nursing college. Regarding Years of experience, 19(40.4) had Less than 5
years of experience, 28(59.6) had more than 5 years. All nurses had
Course training in infections control in hemodialysis units.
Distributions of health workers in hemodialysis units in south Sinai
Governorate, El Tor Facility A consisted of 2(28.6) Doctors, 16(34.0)
Nursing, 33(37.1) Patients. 7(63.6) of patients had Temporary central
venous catheter and 26(33.7) had A-V shunt. Ras Sidr Facility B
consisted of 2(28.6) Doctors, 11(23.4) Nursing, 19(21.3) Patients.
1(14.3) of patients had Temporary central venous catheter and 18(23.3)
had A-V shunt.
Regarding medical disorders of patients,29 had HTN in El Tor Facility A,
11 in Ras Sidr Facility B,6 in Sharm El Sheikh. Facility C ,5 in Dahab
Facility D, 4 in Catherine Facility E, 8 in Abu Radis Facility F. 6 had DM
in El Tor Facility A ,4 in Ras Sidr Facility B,4 in Sharm El Sheikh.
Facility C ,3 in Dahab Facility D, 3 in Catherine Facility E, 3 in Abu
Radis Facility F. 3 had cardiac disease in El Tor Facility A ,2 in Ras Sidr
Facility B,1 in Sharm El Sheikh. Facility C ,1 in Dahab Facility D, 1 in
Summary and Conclusion
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Catherine Facility E, 1 in Abu Radis Facility F. 3 had renal atrophy in El
Tor Facility A ,4 in Ras Sidr Facility B,1 in Sharm El Sheikh. Facility C
,1 in Dahab Facility D, 1 in Catherine Facility E, 4 in Abu Radis Facility
F.
Clinical characteristics of patients in hemodialysis units in southSinai
Governorate,1(14.28) of patients had HBV + in Facility A, HCV +,
presented in 7 patients, 5(15.15) and 1(9.1) in Facility F, HBV & HCV
co-infection,HIV +, MRSA +, wasn’t observed in any case. CPE +
presented in 27 patients ,3(9.1) in Facility A, 3(15.78) in Facility B,
5(41.67) in Facility C, 6(85.71) in Facility D, 4(57.14) in Facility E,
6(54.54) in Facility F. AMR GNB + presented in 17 patients, 7(21.2) in
Facility A, 7(36.8) in Facility B, 2(16.67) in Facility C, 0in Facility D, 0
in Facility E, 1(9.1) in Facility F. Other infections presented in 34,
10(30.3) in Facility A, 0 in Facility B, 5(41.67) in Facility C, 4(57.14) in
Facility D, 5(71.42) in Facility E, 10(90.9) in Facility F. ICU was 3(9.1)
in El Tor Facility A, 4(21.05) % in Ras Sidr Facility B, 0% in Sharm El
Sheikh. Facility C, 1(14.28) in Dahab Facility D,0% in Catherine Facility
E, 0%Abu Radis Facility F. Death patient was 3(9.1) in El Tor Facility A,
2(21.05) in Ras Sidr Facility B, 0% in Sharm El Sheikh. Facility C,0% in
Dahab Facility D, 1(14.28) in Catherine Facility E, 1(9.1)Abu Radis
Facility F. Mortality rate was 9.1%in El Tor Facility A, 10.52% in Ras
Sidr Facility B, 0% in Sharm El Sheikh. Facility C,0% in Dahab Facility
D,14.28% in Catherine Facility E, 9.10%Abu Radis Facility F
Free machines were USED IN 13 in Facility A, 12 in Facility B, 5 in
Facility C, 3 in Facility D, 5 in Facility E and 5 in Facility F.
HCV machines were USED IN 5 in Facility A, 1 in Facility B,0 in
Facility C, 0 in Facility D, 0 in Facility E and 1 in Facility F.
Summary and Conclusion
79
HBV machines, was USED were not used in Facility A,Facility B, and in
Facility C, 1 in Facility D, 0 in Facility E and 0 in Facility F. Total
machine number used for each dialysis treatment, USED IN 18in Facility
A, 13 in Facility B,5 in Facility C, 4 in Facility D,5 in Facility E and 6 in
Facility F.
No. of staff members who connect and disconnect the patient to and from
a machine, USED IN 18 in Facility A, 13 in Facility B,8 in Facility C, 4
in Facility D,4 in Facility E and 6 in Facility F.
Side effect during and after dialysis in hemodialysis units,17(19.1) of
patients had difficulty breathing, 6(18.2) in Facility A, 4(21.0) in Facility
B, 1(8.3) in Facility C, 2(28.5) in Facility D, 2(28.5) in Facility E,
2(18.2)in Facility F. 18(20.2) of patients had Confusion, 6(18.2) in
Facility A, 5(26.3) in Facility B, 2(16.7) in Facility C, 1(14.3) in Facility
D, 2(28.5) in Facility E, 2(18.2) in Facility F. 29(32.6) of patients had
Inflammation in limbs, 15(45.5) in Facility A, 7(36.8) in Facility B,
3(25.0) in Facility C, 1(14.3) in Facility D, 1(14.3) in Facility E, 2(18.2)
in Facility F. 32(35.9) of patients had Fever, 10(30.3) in Facility A,
3(15.8) in Facility B, 5(41.7) in Facility C, 4(57.1) in Facility D, 5(71.4)
in Facility E, 5(45.4)in Facility F. 20(22.4)of patients had Hypotension,
7(21.1)in Facility A, 3(15.8) in Facility B, 2(16.7)in Facility C, 2(28.5))
in Facility D, 2(28.5)) in Facility E, 4(36.3)in Facility F. 19(21.3)of
patients had Muscle cramps, 8(24.2)in Facility A, 3(15.8) in Facility B,
1(8.3)in Facility C, 2(28.5)) in Facility D, 3(42.8)in Facility E, 2(18.2))in
Facility F. 25(28.0) of patients had Itchy skin, 10(30.3) in Facility A,
4(21.0) in Facility B, 3(25.0)in Facility C, 1(14.3)in Facility D, 3(42.8)in
Facility E, 4(36.3)in Facility F. 17(19.1) of patients had Blood clots,
6(18.2)) in Facility A, 2(10.5)in Facility B, 2(16.7))in Facility C,
2(28.5)in Facility D, 3(42.8)in Facility E, 2(18.2)in Facility F. 32(35.9) of
Summary and Conclusion
80
patients had an Infection, 10(30.3) in Facility A, 3(15.8) in Facility B,
5(41.7)in Facility C, 4(57.1)in Facility D, 5(71.4)in Facility E, 5(45.4)in
Facility F. 14(15.7)of patients had Anemia, 6(18.2)in Facility A,
2(10.5)in Facility B, 1(8.3)in Facility C, 1(14.3)in Facility D, 1(14.3)in
Facility E, 3(27.3)in Facility F. 17(19.1) of patients had Fluid overload,
4(12.1) in Facility A, 2(10.5)in Facility B, 2(16.7)in Facility C, 2(28.5)in
Facility D, 3(42.8))in Facility E, 4(36.3)in Facility F. 16(17.9) of patients
had hypertension), 6(18.2) in Facility A, 3(15.8)in Facility B, 2(16.7)in
Facility C, 2(28.5)in Facility D, 2(28.5)in Facility E, 1(9.1)in Facility F.
Infection control related practices in hemodialysis units in south Sinai
Governorate, CDC recommended practices was 70% in El Tor Facility
A, 80% in Ras Sidr Facility B, 90% in Sharm El Sheikh. Facility C, 65%
in Dahab Facility D, 60% in Catherine Facility E, 70% in Abu Radis
Facility F. CDC recommended practices was > 70 in 2 units and ≤70 in 4
units.
There was no significant difference between Sharm El Sheikh and
Catherine hemodialysis units regarding socio‑ demographic and clinical
characteristics of the nursing staff in south Sinai Governorate
There was no significant difference between Sharm El Sheikh and
Catherine hemodialysis units regarding patients’ characteristics(There
was no significant difference between Sharm El Sheikh and Catherine
hemodialysis units regarding patients’ characteristics. Temporary central
venous catheter, Patients with A-V shunt, no, HBV +, no HCV +, no,
HBV & HCV co-infection, no, HIV +, no, MRSA +, no, CPE +, no,
AMR GNB +, no, Other infections , no, ICU administration, no , Death
patient , no, Mortality rate,